Application for consignment authorisation: Movementof controlled waste into Victoria

Industrial Waste Management Policy (Movement of Controlled Waste Between States and Territories)

Form F1006 December 2017

You must read Movement of controlled waste into Victoria (EPA publication IWRG831), prior to completing this form.
For PCB waste movements into Victoria, you must also complete page 2 of this form.

This form must be completed by the producer of the waste.

From / To
Organisation / EPA Victoria
Attn. Development Assessments Unit
GPO Box 4395
Melbourne 3001
Address (origin of waste)
Contact person
Phone / 1300 372 842
Email /
ABN / ACN
I hereby apply for a consignment number for the transport of the waste described below from (list state/territory of origin) to Victoria.
Waste description /
(for PCB waste, you must also complete page 2)
Waste form (select all that apply) / Liquid Sludge Solid
Waste code (List 1) / Contaminants (List 3)
UN number / Dangerous goods class
Bulk/No. of packages
Amount of waste (kg/L/tonnes)
Date(s) of transport / From / / to / /
Method of transport
(select all that apply) / Road Rail Ship
Name of facility receiving waste: / Licence no.
Intended disposal route(s) / Recycling Energy recovery Chemical treatment
Immobilisation Incineration Physical treatment
Storage Landfill Thermal treatment
Other (specify):
If the intended disposal route is storage or immobilisation, indicate the final fate of the waste: / Landfill Other
Briefly note destination:

I declare that to the best of my knowledge the above information is true and correct.

Full name

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Signature / Date / / /

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OFFICIAL USE ONLY

This consignment authorisation must be used in relation to the waste described above, subject to any conditions and limitations attached.

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Authorised Officer / Date / / /

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False and misleading information may lead to enforcement action
This authorisation may be amended or revoked at any time.

Application for consent to sell or supply polychlorinated biphenyls (PCB)

Pursuant to condition 3(a) of the Notifiable Chemical Order (PCB) dated 1 February 2000 (No. S 5)

This consent relates to movement of PCB into Victoria. You must read Polychlorinated biphenyls (PCB) management (EPA publication IWRG643) prior to completing this form.

Waste concentration mg/kg /
(attach copy of NATA-endorsed analytical report for volume and concentration for each item of equipment – refer to Polychlorinated biphenyls (PCB) management (EPA publication IWRG643)).
Treatment type / (If you have indicated "Other" as the intended the disposal route, you must specify the proposed treatment type e.g. blending.)
Where the treatment facility is not the final destination, indicate the final destination of the waste
Name of facility of final destination / EPA Licence no.
Treatment type

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Signature / Date / / /

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Approval is granted subject to following conditions and any further conditions or limitations attached:
1.  All details contained in the application for consignment number and PCB waste movement are true and correct.
2.  The Authority is notified immediately of any proposed changes to the details contained in the application.
3.  This approval relates only to movement of PCB waste into Victoria. You must also obtain approval from other jurisdictions for PCB waste being moved from Victoria.
4.  Movement of PCB waste not occurring until all approvals are granted.
5.  In accordance with clause 3(g) of the Variation of an Order relating to Notifiable Chemicals you must obtain a destruction/disposal certificate from the receiving facility.
6.  You must comply with any conditions imposed for any interstate movement of PCB waste under the National Environment Protection Measure ‘Movement of Controlled Waste Between States and Territories’.
Pursuant to clause 3 of the Variation of an Order relating to Notifiable Chemicals dated 1 February 2000 (No. S 5) the Authority grants approval to sell/supply PCB waste subject to your application dated / /

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Authorised Officer / Date / / /

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False and misleading information may lead to enforcement action.
This authorisation may be amended or revoked at any time.

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